SLEEPWELLNESSCENTERWINMARDIAGNOSTICSINC. Issue1

Sleep Wellness Center Winmar Diagnostics Inc.

Spring/Summer 2016

WHENSLEEPBECOMESATEAMSPORT INTHISISSUE

Asthegroundthawsandthegrassgreensweareremindedhowresilientwecanbe.Wedustoffthosewinterblahsandwelcomespringwithopenarms.NewexperiencesarethesparkoflifeandwehereatSleepWellnessCenterinFargoandGrandForksareexcitedaboutbringingyouournewnewslettertobrightenyourday.Weareheretoassistyouwithyourpatient’ssleeprelatedneeds.Thenewsletterwillbeforprovidersandpatients.Wehopeyoufindthefollowingarticlestobeinformativeandhelpful.Enjoy!

Sleep becomes a team sport Whenpeoplestarttoexperiencesleepingissuesbigorsmallwewouldliketohelpresolvethoseissuesandmovethemforwardtoabetterqualityoflifeasfastaspossible.Ifyoucansleep,youcanheal.Theoppositealsoistrue,ifyoucannotsleep,youcannotheal.Ifthelatteristrueforyouoryourpatient,thenacycleofunpleasantexperiencesbegins.Thiscycleofbrokensleepbeginstoaffecttheirmarriages,jobs,friendandfamilyinteractions,aswellas,theirhealth.Whenwedon’tfeelgoodwedonotperformtothebestofourabilitiesordesires.So,thefirststeptowardenjoyingagoodnight’ssleepisgettingproperlydiagnosed.AtSleepWellnessCenter,allof

oursleepspecialistsareregisteredorcertifiedinsleeptechnologies.Weofferacomfortable,home-likeatmospherewhereyourpatientscanrelaxandtrustthatoursleepexpertswillhelpyoufindanswerstoyoursleepissuesandrelieffromwhateverispreventingyoufromgettingtherestfulsleepyouneed.Wehavebeenhelpingpatientssince1994.

Get started with a referral Insurancerequiresyourpatienttohaveaphysician’sreferraltoreceivesleepdiagnosticcareandequipmentjustliketheywouldforanyothertypeoftesting.Themajorityofpatientsdonotneedtoseeaspecialsleepdoctor;alltheyneedtodoisaskyou,theirprimarycarephysician,tocompleteareferralformforthemtoseeoneofoursleepspecialists.Itwillnotrequireyourpatienttoaddanotherdoctortotheirhealthcareteamorinitiateastringofadditionalappointments.We’llsimplycompletethediagnosisprocessandcoordinateatreatmentplanwithyou,theirprimarycarephysician.Referralformsareavailableonourwebsite:www.sleepwellnessnd.comandclickon“Resources”.

Provider interests ArticlestohelpmakingreferringsleepstudiestoSleepWellnessCenterinFargoeasier.

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Patient interests Informationthatwillhelpwithcomplianceandease-of-useforeachpatientthathashadasleepstudyandmayuseaPAPdevicetofeelbetteraftersleeping.

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Welcoming Spring byStephaniePrivratskyBushee

SLEEPWELLNESSCENTERWINMARDIAGNOSTICSINC.|Issue1 2

All insurances accepted Weacceptallinsurances,includingMedicare,andwhenyourpatientisreferredtoSleepWellnessCenter,we’lldoalltheinsurancepaperworkforthem.

What happens at a sleep study Whenyourpatientarrivesfortheirsleepstudy,theirsleeptechnicianwillmeetthemandshowthemtotheirbedroom.They’llhavetimetochangeandgetreadyforbedastheynormallywould.Theremaybesomewaitingperiodswhilewepreparethemonitorsandsleepconditionsduringwhichthey’llbewelcometoreadorwatchTV.Wheneverythingisready,theirtechnicianwillattachmonitoringequipmentwhichwilltakeabout20minutes.Therewillthenbea10–15minutewaitingperiodinwhichweallowtheadhesivestodry.Thenit’slightsoutandthey’llbefreetosleep.

Whiletheyaresleeping,theirsleeptechnicianwillmonitortheirbrainwaves,bloodoxygenlevels,heartrate,andbreathing,aswellasmuscle,eye,andlegmovements.Ifenoughbreathingdisturbancesarerecorded,thesleepstudytechnicianwillawakenthemtotryusingcontinuouspositiveairwaypressure(CPAP)toseeifthisimprovestheirsleep.SomepatientsmaybeaskedtoreturnforasecondsleepstudytotrytheCPAPtherapy.

Thesleeptechnicianswillnotbeabletogivethemanyresultsthenightoftheirsleepstudy.Atthecompletionoftheirsleepstudy,ourteamofsleepexpertswilltaketimetoanalyzeallthedatacollectedfromthesleepstudymonitorsandprepareacomprehensivesummaryalongwiththerapyrecommendations,ifapplicable.Thisprocessmaytakeuptotwoweeks.

Acompletesleepstudyreportincludingrecommendationsforfollow-upcarewillbesenttoyou,yourpatient’sprimarycarephysician.IftheytriedtheCPAPtherapyduringtheirsleepstudy,therearetwooptionsforyourpreferences:1.WesetupyourpatientwithCPAPandtheyuseditfor1monthandthenyouscheduleavisitwiththemonhowitisgoingor2.Youmeetwiththepatientfirstanddiscussfindingsofthesleepstudybeforetheybegintherapy.Wewillcontactyourpatientoncewegetyourpreferenceandsetupanappointmenttogettheirequipment.

You’ll appreciate our follow-up care OneofthekeyadvantagestochoosingSleepWellnessCenterisourfollow-upcare

program.WeprovideeachpatientwithaplanofcarethatstartswiththePAPtherapybeingsetup.We’llkeepintouchwithyourpatientstomakesuretheirpersonalsleeptherapycontinuestoworkforthem,andyou’llbehappytoknowtherearenochargesforfollow-upofficevisitsorequipmentchecksat SleepWellnessCenter.Wejustwanttomakesuretheyaredoingwell.

CPAP compliance program Forexample,atthetimeofsetupofthetherapydevice,thepatientisenrolledintheSleepWellnessCenter’shometherapyfollowupprogram.Informationprovidedupontheinitialsetupcanbeoverwhelming,whichiswhyclosefollowupissoimportant.StudiesindicatethatthefirstmonthoftherapyisacrucialpartoflongtermcompliancewithCPAPtherapy.Thepatientiscontacted72hoursaftertheinitialsetup.Ifallisgoingwell,wecontactthepatient30daysfromsetupandevery90daysthereafter.Ifthepatienthasanyconcernsafterthefirst72hours,wewillcontacthim/hereveryfewdaysuntiltheproblemorconcernhasbeenresolved.ForMedicarepatients,inadditiontothefollowupnotedabove,willbefollowedmonthlyforthefirst13monthsoftherapy.ThisadditionalfollowupisrequiredtomeetthestrictMedicareguidelines.Plus,weoffer24houroncallservicetomeettheneedsofanyafter-hoursconcerns.

Compliance and monitoring Monitoringefficacyandcomplianceareanimportantfacetofthefollowupprogram.Adatadownloadisperformedapproximately30daysaftereveryCPAP/BiPAPsetup.Areportisthensenttoyou,theprovider,informingyouoftheusageandsuccessoftheprescribedtherapyforyourpatient.YoumaybeaskedtosendfollowupnotestoSleepWellnessCenterfollowingyourvisitwiththepatient.ThisinformationisoftenrequiredbyMedicareorthehealthinsurancetoinsureproperpaymentofthedevice.Ourcurrentcompliancerateisconsistentlygreaterthan90%.

Home sleep studies (HST) Weworkdiligentlytokeepyourfacilityandprovidersuptodateonthelatestchangesintestingandreimbursementinourserviceareas.OverthepastfewmonthstherehavebeensomechangesnotedinOutofCenterTesting(Homesleepstudies,HST)thatmayaffectsomepatientsinourservicearea.

TheAmericanAcademyofSleepMedicine(AASM)hassetinplacetheguidelinesforHST.AsasleepcenterthatisaccreditedbytheAASMasanOutofCenterTestingfacilitywearerequiredtofollowthestandardsthathavebeensetinplacebytheAASM.TherearesomeinsurancecompaniesthatoverridetheAASMguidelines,andhaveestablishedtheirownguidelines.Thesevaryfromcompanytocompany.

TherearecurrentlyonlyafewinsurancecompaniesintheareathatarebeginningtorequireHSTasaninitialstudyfortheircustomers.TheneedfortheHSTismostoftendiscoveredduringtheinsuranceverificationprocessthatwecompleteforthepatient.IfitisdiscoveredthatapatientisrequiredtohaveanHSTwewillcontacttheprovider’sofficetoletthemknowofthischangeinlevelofservice.Thenthepatientwillbecontacted,byourcenter,toletthemknowandarrangementsaremadefortheHST.

WinmarcurrentlyhasthemostuptodateequipmentforperformingHST.Wemeetwiththepatientindividuallytoassureagoodunderstandingoftheuseoftheequipment.

Thereisan“oncall”numberforthepatienttocallincaseofquestionsorproblemsduringthenight.Uponcompletionofthetestingthepatientreturnstheequipmenttoawaitanalysisandinterpretation.

SLEEPWELLNESSCENTERWINMARDIAGNOSTICSINC.|Issue1 3

Home sleep studies conti: ThebillingfortheHSTiscurrentlyrequiredtobesubmittedthroughthesleeplab.IfthepatientrequiresPAPtherapy,someoftheinsurancesareallowingforanattendedorinlabstudyfortheCPAPtitration,othersrequirehometitrationwithauto-PAP.EitherwayacarefollowupprogramisrecommendedtoassurethatthepatientisabletobecomecompliantwithPAPtherapyinthehome.

Home sleep testing guidelines TheAmericanAcademyofSleepMedicine(AASM)haspublishedsuggestedguidelinesfortheuseofhomesleepstudiesinthediagnosisofobstructivesleepapnea(OSA):

Ü Patientswithahighpre-testprobabilityofmoderatetosevereOSA.

Ü Patientswithnosignificantco-morbidmedicalcondition.Examplesofco-morbidconditionsincludemoderate-severepulmonarydisease(cysticfibrosis,pulmonaryfibrosis,activeasthma,COPD),congestiveheartfailureandneuromusculardiseases(ALS,multiplesclerosis,Parkinson’sdisease).

Ü Patientssuspectedofhavingnoco-morbidsleepdisorderotherthanOSA.

Ü Patientsunabletobestudiedinasleeplaboratory.

Ü Tomonitorresponsetonon-PAPtreatmentsafterthediagnosishasalreadybeenmade.

Ü TheAASMrecommendedthatHSTisnotappropriateforgeneralscreeningofasymptomaticpatients.

CPAPCOMPLIANCERATE90%

OurcurrentCPAPcompliancerateisconsistentlygreaterthan90%.ThisisduetotheknowledgeableclinicianandsupportstaffhereatSleepWellnessCenter.

ObstructiveSleepApnea(OSA)isahottopicofdiscussioninandaroundtheDepartmentofTransportation(DOT),FederalMotorCarrierSafetyAdministration(FMCSA),andFederalRailroadAdministration(FRA)agencies.IntheMarch2016issueofSleepReviewMagazine,article”AASMUrgesFederalAgenciestoDevelopSleepApneaPoliciesforCommercialMotorVehicleDrivers,TrainEngineers,”theAmericanAcademyofSleepMedicine(AASM)urgestheseagenciestocomeupwithpoliciesregardingsleepapnea.TheDOT,FMCSA,andFRAareaskingforpublicinputduringthenext90daysregardingtheimpactsoftreating,evaluating,andscreeningpersonsforOSAwhomworkfortherailroadorarecommercialmotorvehicledrivers.TheAASMcommendsthiseffort.FMCSA,andFRAwillmeetinWashington,D.C.,andLosAngeles,andwillbehostingthreepubliclisteningsessions.TheFMCSAandFRAareconsideringwhethertopurpose

specificrequirements.TodothisajointAdvanceNoticeofProposedRulemaking(ANPRM)hasbeeninitiated.AnANPRMisadocumentthatanagencymaychoosetoissuebeforeitisreadytoissueaNoticeofProposedRulemaking(NPRM).Itmayalsobecalleda"noticeofintent"orsimplya"requestforcomments."TheANPRMisusedbyanagencyasavehicleforobtainingpublicparticipationintheformulationofaregulatorychangebeforetheagencyhasdonesignificantresearchorinvestigationonitsown.TheAASMpresidentNathanielWatson,MD,MScsays“Thecomprehensivedevelopmentandswiftimplementationofevidence-basedsleepapneapoliciesisnecessarytoprotectthewell-beingoftransportationoperatorsandmaximizepublicsafety.”PeoplewithOSAstruggletobreathe,whichresultsinsnoring,canoccurseveralhundredtimeseachnightwhichexplainswhytheirbodyisexhausted,nightafternightevenafter8to10hoursofsleep.

Leftuntreated,sleepapneahasbeenlinkedtoheartproblems,highbloodpressure,diabetes,weightgain,depression,impotence,andevensuddendeathwhilesleeping.Itisestimatedthat25millionadultshaveOSAand20%+arecommercialtruckdrivers.Daytimesleepinesscancausedrowsydrivingwhichiswhytheseagenciesaremovingaheadwiththefirststepsofchange.“Healthysleepandoptimalalertnessareessentialfortransportationsafety,”saysWatson.“AcrosstheUS,thousandsofboard-certifiedsleepmedicinephysiciansareavailabletoprovidehighquality,patient-centeredforpeoplewhohavesleepapnea,whichhelpstokeepourroadsandrailwayssafe.”

Department of Transportation, Federal Motor Carrier Safety Administration, and Federal Railroad Administration byStephaniePrivratskyBushee

SLEEPWELLNESSCENTERWINMARDIAGNOSTICSINC.|Issue1 4

PatientInterestsCPAP supplies

ThesleepprofessionalsatSleepWellnessCenterthankyouforyourcontinuedbusiness.Properlymaintainingyourdeviceandkeepingyourequipmentuptodateisthebestwaytoensurethatyourtherapyremainscomfortableandeffective.Awornmask,looseheadgearoracloggedairfiltercanreducethecomfortandeffectivenessofyourtherapy.

Belowisa“guide”tohelpyoudecideifnewsuppliesareinorder.Youcanorderbyeithercallingourofficeat(701)235-7424or(800)962-8145orbysendingtheorderinbymail.Ifyouarenotsurewhenyoulastreplacedyourequipmentorifyouareeligibleforreplacementsupplies,pleasefeelfreetocallandwewouldbehappytohelpyou.

Ifyouwouldlikeustohelpyoudetermineifyouareeligibleforreplacementsuppliespleasecallorstopintotheoffice.Fillouttheformandmailin,orcallanytimetosetupaone-on-oneappointment!

NAME:______________________________________

EMAILADDRESS:______________________________________

ADDRESS:______________________________________

______________________________________

CurrentInsurance:______________________________________

PolicyNumber:______________________________________

CurrentProvider/Physician:______________________________________

Suppliesneeded:

______Mask______Tubing______Cushions/Pillows*______Size______WaterChamber______Filters

*IfMedicareisyourprimaryinsurance,theyrequirethatwespeaktoyoupriortosuppliesbeingsentoutinthemail.

Sleep Wellness Center Winmar Diagnostics, Inc.

270012thAve.S.SuiteB|Fargo,ND58103|701-235-7424TollFree800-962-8145Fax701-239-4792

1191S.ColumbiaRoad|GrandForks,ND58201|701-746-7378TollFree800-962-8145Fax701-746-7388(Inside:HeartInstituteofNorthDakota)

ThankyouforchoosingSleepWellnessCenterandwelookforwardtohelpingyoucontinuetoenjoythepeaceful,revitalizingsleepyoudeserve.

Order Schedule Mostinsurancecompaniesallowforreplacementpartsonaregularbasis.RefertothisreplacementschedulereferenceguidetohelpyourememberwhentoorderyourCPAPsupplies.Youarealsowelcome,atyourownexpense,toorderextrasuppliesfortravelortokeepatvacationhomes.

Product ReplacementSchedule

Mask(includesseal) 1per3months

Full-facesealreplacement

1permonth

Nasalsealornasalpillowreplacement

2permonth

Chinstrap 1per6months

CPAP/BIPAPtubing 1per3months

CPAP/BIPAPfilter(disposable)

2permonth

CPAP/BIPAPfilter(non-disposable)

1per6months

CPAP/BIPAPhumidifierwaterchamber

1per6months

ReplacementCPAP/BIPAPunit

Consultyourprovider

Sleep Disorders ObstructiveSleepApnea(OSA),alsoknownassleepapnea,isasleepdisorderconditionwherethepersonmomentarilystopsbreathingwhileasleepbecausethemusclesthatcontrolyourupperairwayrelaxtoomuch,narrowingorevencompletelyblockingyourairway.Thestruggletobreathe,whichresultsinsnoring,canoccurseveralhundredtimeseachnightwhichexplainswhyyourbodyisexhausted,nightafternightevenafter8to10hoursofsleep.Leftuntreated,sleepapneahasbeenlinkedtoheartproblems,highbloodpressure,diabetes,weightgain,depression,impotence,andevensuddendeathwhilesleeping.Peopleofallagescandevelopsleepapnea,andmostdon’trealizetheyhaveitunlessafamilymembergetsirritatedbydisruptivesnoringoranursenoticesasleepdisruptionduringahospitalstay.Itismostcommonforpeoplewhoareoverweightorhavealargeneckwhichconstrictstheupperairway. Asleepstudywilldetermineifyouhavesleepapnea,whichisatreatableissue.

Insomniaistheinabilitytosleeporhabitualsleeplessness.Itcanbebroughtonbyphysical,environmental,orpsychologicalcausessuchasbreathingdisorders,noise,chronicdepression,orstress.Anothercommoncauseofinsomniaistheoveruseofsleepingpills.SleepWellnessCentercanworkwithyoutodeterminethecauseofyourinsomniathroughsleepdiaries,sleephygienehabits,and/orasleepstudy.We’llalsohelpyouovercomeyourinsomniawithbehavioralchangesandmedication,ifnecessary.

ShiftWorkDisorderiswhentheregularwakingandsleepingpatternisdisrupted,somepeoplefinditdifficulttoresumeasleep–wakeschedulethatfitstheirneeds.Thisiscommonamongshiftworkersandpeoplewhoexperienceachangeintheirschedule.Itcanleadtoinsomniaanddaytimesleepinesswhenitinterfereswiththewakerhythm.We’llworkwithyoutohelp“reset”yourbody’ssleepclocksoyoucanstillmaintainahealthylifestylewhiledoingshiftworkandschedulechanges.

Youcanfindoutaboutmoredisordersonourwebsite:www.sleepwellnessnd.com/sleep-disorders

SLEEPWELLNESSCENTERWINMARDIAGNOSTICSINC.|Issue1 5

Nowthatyouhavehadyoursleepstudyyoumayhavetochangethewayyouaresleepingduetotheresults.Youarenotalone.PeoplewhoarediagnosedwithsomeformofsleepdisorderbreathingmayhavetowearaPositiveAirwayPressure(PAP)device.ThetypeyouwereprescribedmaybeaCPAP,BiPAP,orother,dependingontheresultsofyoursleepstudy.Youmaybethinking“Whyisthishappeningtome?”or“WhydoIhavetowearthismask?”Itishardatfirsttoacceptthistypeofchange.Dependingonhowyouhandleanychangewilldeterminehowfastyouadapttothisnewchangeinyoursleepingroutine.Restassuredwewillhelpyoumakeittotheotherside,whichisfeelingbetterwhenyouwakebecauseyouwereabletowearyourCPAPallnightlong.

DesensitizingisawayyougetusedtousingyourCPAP,sothatitbecomessecondnaturetoyou.Everytimeyousleepyouuseyourprescribedequipmentconsistently.Thiswillgiveyouthebestresults,quicker.How,youmayask,canwegetthisdoneforyou?Thinkofitthisway,ifyouregularlywearawatchonyourleftarmandthenallofasuddenstartedwearingityourrightarm,itwouldfeelweird,right?Thisishowyourmaskandequipmentfeel,initially.Helpingyouacclimatetoyournewequipmentiswhatwedoforyou,ourpatients.Thefirsttwoweeksarethemostimportant.SetpersonalgoalsfortheamountoftimeyouhopetowearyourCPAP,takeabreakifneeded.Themostimportantruleistoputonyourequipmenteverynight.IfyoupickandchoosethenightsyouuseyourCPAPyouwillneverreachdesensitization.Ifyouarestrugglingwithyourpressure,mask,orhumidificationwehavecliniciansonstaffhereatSleepWellnessCenterwhoknowtheinsandoutsofyourequipmentandwhocantroubleshootwithyouinpersonoroverthephone.Wewillcontinuetofollowupwithyoutoensurethedesensitizinghasworkedwellforyou.Wewillhaveyoufeelingbrighteyedandbushytailedinnotime.

Getting Used to Your New Way of Sleeping - Desensitizing byStephaniePrivratskyBushee

Word Search - Sleep

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APNEA

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DREAMING DROWSY FARGO HOSE

HUMIDITY INSURANCE

MASK NASAL

OBSTRUCTIVE OXIMETRY

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SLEEP TEAM

TESTING TRAINING TREATMENT